The First Facility Management Blog

For the protection of frontline healthcare and emergency medical workers at high risk of infection, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued a compliance directive to ensure uniform procedures when conducting inspections to identify and minimize or eliminate high to very high risk occupational exposures to the 2009 H1N1 influenza A virus.

The directive closely follows the Centers for Disease Control’s guidance.

“OSHA has a responsibility to ensure that the more than nine million frontline healthcare workers in the United States are protected to the extent possible against exposure to the virus,” said acting Assistant Secretary of Labor for OSHA Jordan Barab. “OSHA will ensure healthcare employers use proper controls to protect all workers, particularly those who are at high or very high risk of exposure.”

In response to complaints, OSHA inspectors will ensure that healthcare employers implement a hierarchy of controls and encourage vaccination and other work practices recommended by the CDC. Where respirators are required to be used, the OSHA Respiratory Protection standard must be followed, including worker training and fit testing. The directive also applies to institutional settings where some workers may have similar exposures, such as schools and correctional facilities.

The CDC recommends the use of respiratory protection that is at least as protective as a fit tested disposable N95 respirator for healthcare personnel who are in close contact (within 6′) with patients who have suspected or confirmed 2009 H1N1 influenza. Where respirators are not commercially available, an employer will be considered to be in compliance if the employer can show a good faith effort has been made to acquire respirators.

Where OSHA inspectors determine that a facility has not violated any OSHA requirements but that additional measures could enhance the protection of employees, OSHA may provide the employer with a hazard alert letter outlining suggested measures to further protect workers.

The 2009 H1N1 influenza is transmitted via direct or indirect person-to-person spreading of infectious droplets passed when an influenza patient coughs, sneezes, talks, or breathes. Transmission occurs when expelled infectious droplets or particles make direct or indirect contact with the mucus membranes of the mouth, nose or eyes of an uninfected person. The OSHA directive and other guidelines show steps to eliminate the hazard.

Under the Occupational Safety and Health Act of 1970, OSHA’s role is to promote safe and healthful working conditions for America’s men and women by setting and enforcing standards, and providing training, outreach and education.

The Facility Guidelines Institute (FGI) has published its 2010 edition of the Guidelines for Design and Construction of Health Care Facilities. Updated every four years, the FGI Guidelines are currently used by more than 42 states and several federal agencies to regulate health care facility design and construction around the United States.

The 2010 revision cycle has resulted in a revised document with new material and updates to the language of the 2006 edition of the Guidelines. Completely new language includes material on preparation of a patient handling and movement assessment (PHAMA) as part of planning for health care facility projects; recommendations for the design of bariatric and medical oncology units and cancer treatment facilities; and guidance on acoustic design for health care facilities. A detailed white paper describing how to prepare a PHAMA is available for download from the FGI Web site, accompanying the release date of the 2010 edition.

Another significant change to the Guidelines is the incorporation of the 2008 edition of ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities as Part 6 of the document. This merger is intended to eliminate any confusion caused by having two national ventilation standards for health care.

Additional highlights in the 2010 FGI Guidelines include:

• Updated requirements for the design of hand washing stations;
• Design information for technology and medical communication rooms;
• A new appendix on performing patient safety risk assessments;
• New material on selecting surfaces and furnishings;
• Updated design for protective environment rooms;
• New appendix on wayfinding features;
• Design information for accommodating bariatric patients in the emergency department;
• Movement of emergency department pediatric rooms and fast-track areas from the appendix to the main text;
• Updated requirements for obstetrical facilities; and
• Revised organization and numbering to make similar requirements in different locations easier to find.

The 2010 edition is being published in three formats—a bound book, a loose-leaf version for placement in a three-ring binder, and a searchable CD. The 2010 edition provides owners, clinical users, design professionals, constructors, and authorities having jurisdiction (AHJs) with a wealth of professional expertise as well as the full text of ASHRAE Standard 170, white papers on acoustics and on patient handling and movement, draft guidelines for critical access hospitals, and a resource guide on the selection of surfaces and furnishings for health care facilities.

When Credit Valley Hospital (CVH) in Mississauga, Ontario was originally commissioned in 1985, drinking fountains were not viewed as a threatening source of communicable diseases. However, several years ago, faced with growing concerns after a deadly infectious outbreak of C. difficile in an Ontario hospital, the 365-bed CVH needed to pursue new infection control measures.

Farrow Partnership Architects (FPA), a firm located in Toronto, saw that CVH’s drinking fountains, which had been decommissioned but still had an existing built-in source of water, could be converted into a hand washing units as a positive force for infection control.

One of 15 drinking fountains converted to infection control units in Credit Valley Hospital in Ontario.

According to Health Canada, hospital-acquired infections kill some 8,000 to 12,000 patients across that country every year, and cost the health system millions of dollars. The Canadian Health Network points out that hands spread an estimated 80% of common infectious diseases, yet studies show less than half of hospital nurses and physicians clean their hands between patients.

In 2008, working with CVH’s infection control and maintenance managers, FPA developed and implemented 15 hand washing units in the corridor of an inpatient care area over a one-month period. Aimed primarily at reducing the spread of infection, it was also recognized that improvements in hand washing facilities would reduce the risk of legal action resulting from infection disease outbreaks.

These hand washing units were designed in the absence of any government performance guidelines, specifications, or industry standards. At the start of this initiative, FPA and CVH created the following criteria for success that was realized through the ultimate design:

• Convenience and ease of use: reduced the significant time loss incurred by busy doctors and nurses walking to a distant location many times a day
• Minimal spread of contaminated water: deep basin reduces splashing of soiled water
• Minimal amount of physical contact: faucet with hands-free operation
• Rapid prototyping: off theshelf components were used where possible to reduce implementation time (e.g., regular paper towel dispenser and disposal)
• Ease of installation: developed a self contained unit for ease of installation into new or existing plumbing
• Warm and inviting materials: selected solid surface material over the more clinical standard stainless steel products
• Supportive of maintenance programs: solid surface material conducive to low maintenance and ease of cleaning

Diverse participants contributed to the success of the hand washing units including the hospital’s infection control committee, various doctors and nurses, and the maintenance staff. FPA worked with a subcontractor and Wilsonart to develop the prototypes and final product. Nurses and infection control committee members commented on the first prototype and minor adjustments were made, which included a curved front to facilitate cleaning and to create a more elegant looking shape. A second prototype, complete with plumbing and antiseptic gel, was developed and put into use over a two-week period.

Ultimately 15 final versions of the hand washing units were installed in 2008, and more will be added as funding becomes available.

(Photo: Tom Arban)

The AEDG for Small Hospitals and Healthcare Facilities is the sixth in the 30% Advanced Energy Design Guide (AEDG) series designed to provide recommendations for achieving 30% energy savings over the minimum code requirements of ANSI/ASHRAE/IESNA Standard 90.1-1999.

“The recommendations in the Small Hospitals and Healthcare Facilities Guide provide good design practices for integrating energy efficiency in a healthcare environment, while maintaining indoor air quality and required airflow and pressurization relationships,” Shanti Pless, chair of committee that wrote the guide, said.

The Guide focuses on small healthcare facilities up to 90,000 square feet in size, including acute care facilities, outpatient surgery centers, critical access hospitals, and inpatient community hospitals. These buildings have intensive heating and cooling systems, which the Guide covers extensively; additionally, other important energy saving measures such as daylighting are included.

“The energy efficiency recommendations in the Guide were developed based on design experiences from members of a project committee made up of healthcare facilities design professionals, combined with the insight gained from modeling the energy performance of these specific recommendations,” Pless said.

Some tips that the Guide offers include:

• Providing an unoccupied air flow and temperature setback for spaces that are not used 24 hours a day, such as surgery suites;
• Installing high efficiency condensing boilers with an outdoor air temperature reset schedule for all climate zones to address the high amounts of reheat energy used by such facilities to control humidity;
• Carefully laying out lighting design to meet recommended lighting power density by space type;
• Maximizing the use of daylighting and daylighting-responsive controls through both side lighting and top lighting strategies in all space types that do not have air change requirements;
• Installing an insulated thermal envelope, with additional recommendations to address air barriers and continuous insulation strategies.

The recommendations allow contractors, consulting engineers, architects, and designers to achieve advanced levels of energy savings easily without having to resort to detailed calculations or analyses.

Also, case studies provide examples of advanced hospital and healthcare facility designs that demonstrate the flexibility offered in achieving advanced energy savings such as the 30% goal of the Guide.

The AEDG series has been developed in collaboration with these partnering organizations: ASHRAE, the American Institute of Architects (AIA), the Illuminating Engineering Society of North America (IES), the U.S. Green Building Council (USGBC), and the U.S. Department of Energy (DOE). Since the Guides first began to be offered in early 2008, more than 200,000 have been downloaded. Other books in the series deal with small office and retail buildings, K-12 school buildings, highway lodging and small warehouse and self storage buildings.

For a free copy of the latest AEDG, send an e-mail to tfm@groupc.com with the words “AEDG Healthcare” in the subject line. For other versions of these guides, visit www.ashrae.org/freeaedg.

National Office Furniture recently announced it will give a $25,000 Gift of Inspiration for Healthcare Environments to one lucky facility next spring. The Jasper, IN-based company decided to provide these funds to help one organization tackle some of the many challenges the healthcare industry faces. The gift can be used to support the needs of healthcare environments in areas such as technology, the patient experience, staff morale, training and enrichment programs, or facility enhancement.

From now until March 31, 2010, healthcare organizations can enter for a chance to win this prize. Facility managers can do this by registering their organizations at the company’s Web site.

“At National, we understand healthcare organizations require a multitude of resources in providing extraordinary care to so many people. This gift is intended to enhance healthcare environments and inspire ideas that will enrich the lives of caregivers and care recipients,” says Don Van Winkle, vice president, general manager at the company.

For the protection of frontline healthcare and emergency medical workers at high risk of infection, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued a compliance directive earlier this week to ensure uniform procedures when conducting inspections to identify and minimize or eliminate high to very high risk occupational exposures to the 2009 H1N1 influenza A virus.The directive, which closely follows the Centers for Disease Control’s (CDC) guidance, is available as a PDF.

“OSHA has a responsibility to ensure that the more than nine million frontline healthcare workers in the United States are protected to the extent possible against exposure to the virus,” said acting Assistant Secretary of Labor for OSHA Jordan Barab. “OSHA will ensure healthcare employers use proper controls to protect all workers, particularly those who are at high or very high risk of exposure.”

In response to complaints, OSHA inspectors will ensure that healthcare employers implement a hierarchy of controls, and encourage vaccination and other work practices recommended by the CDC. Where respirators are required to be used, the OSHA Respiratory Protection standard must be followed, including worker training and fit testing. The directive also applies to institutional settings where some workers may have similar exposures, such as schools and correctional facilities.

The CDC recommends the use of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact (within six feet) with patients who have suspected or confirmed 2009 H1N1 influenza.

Where respirators are not commercially available, an employer will be considered to be in compliance if the employer can show a good faith effort has been made to acquire respirators.

Where OSHA inspectors determine that a facility has not violated any OSHA requirements but that additional measures could enhance the protection of employees, OSHA may provide the employer with a hazard alert letter outlining suggested measures to protect workers further.

The 2009 H1N1 influenza is transmitted via direct or indirect person-to-person spreading of infectious droplets passed when an influenza patient coughs, sneezes, talks, or breathes. Transmission occurs when expelled infectious droplets or particles make direct or indirect contact with the mucus membranes of the mouth, nose, or eyes of an uninfected person. The OSHA directive and other guidelines show steps to eliminate the hazard.

Under the Occupational Safety and Health Act of 1970, OSHA’s role is to promote safe and healthful working conditions for America’s men and women by setting and enforcing standards, and providing training, outreach and education.

A new U.S. Department of Veterans Affairs (VA) report, Report of the Task Group for Innovative 21st Century Building Environments for VA Healthcare Delivery, prepared by the National Institute of Building Sciences (NIBS) could help the federal agency move its healthcare facilities into the 21st century. The task group concludes, “VA is in a position to transform and lead healthcare delivery into a completely new and revolutionary force within our society.”

In 2008, officials at the VA asked NIBS to coordinate the organization’s exploration for a new paradigm to provide a new generation of high-performance, sustainable healthcare environments for the changing population of veterans. The Institute convened a multi-disciplinary task group to investigate and document state-of-the-art practices for flexible healing environments.

Made up of of more than 25 architects, engineers, hospital administrators, healthcare professionals, and other renowned experts in the healthcare industry, the task group worked with a VA advisory group that provided data and information on the current practices of VA operations and facilities. The task group developed five principal conclusions with supporting recommendations applicable to transforming new and renovated healthcare facilities. If implemented, these recommendations would provide the VA with a model that is paramount to the future success of veteran healthcare delivery and without precedent in the U.S. healthcare industry.

A pdf of the executive summary of the report is available for free download here: Executive Summary. To request pdfs of the full report (which is available in two sections), send an e-mail to tfm@groupc.com with the words VA Healthcare Report in the subject line of your correspondence.

On June 7, 2008, record flooding from nearby Haw Creek filled the basement and up to six inches on the first floor of Columbus Regional Hospital in Columbus, IN,  forcing the hospital to evacuate 157 patients. The laboratory, pharmacy, IT center, radiology equipment, medical records, and food service facility that were housed in the hospital’s basement were destroyed. The hospital sustained more than $200 million in damages and was forced to close during recovery and rebuilding efforts. Initial estimates put this process at 10 to 12 months, but through the hard work of hospital employees and countless volunteers Columbus Regional Hospital reopened its doors October 27, 2008, less than five months after the flooding.

Following is the story of the response and recovery.

Flooding in Columbus, IN around the Columbus Regional Hospital

Dave Lenart, director of facilities and materials management at Columbus Regional Hospital, was surprised when he received a call from hospital CEO Jim Bickel on a rainy Saturday afternoon. Bickel wanted to know what the hospital’s emergency plan was if the creek behind it overflowed. Lenart told Bickel that he had discussed this scenario with security in the past and they had planned to reroute parking as necessary, but noted that he had never seen the creek overflow. Bickel also wanted to know if Lenart could get sandbags delivered to the hospital quickly.

Lenart began calling contractors to deliver sandbags to the hospital and rallied his facilities team as well. He tried calling the hospital’s main phone line and thought it was unusual that the line was busy, but chalked it up to high call volume. After a second attempt to get through, Lenart knew something was wrong. If there was any potential for flooding at the hospital, the basement where the phone switch was located, would be vulnerable. Lenart contacted Martha Myers, Columbus Regional Hospital’s manager of risk and safety services, on her cell phone as he headed to the hospital.

All the typical routes to the hospital were flooded and it took Lenart more than an hour to make the normally 20-minute trip from his home. Lenart described his approach to the hospital buildings like “walking toward a combat zone” and reported that the amount of water present was staggering. Physicians, hospital staff, first responders, military men and women, state police, and community volunteers were working quickly to evacuate the second and third floors of the hospital, set up a staging area in a small parking lot and begin transporting patients to nearby healthcare facilities.

The basement and first floor of the hospital were affected by the flooding.

Lenart began retrieving wheelchairs and stretchers to support evacuation efforts on the upper floors. Next, he turned his attention to ensuring the hospital’s infrastructure - electricity, water and communications - were running when they could. He worked with hospital contractors to bring in lighting, portable toilets and other necessities. At 1:30 a.m. Sunday, when the water had subsided, Lenart and Bickel walked through the evacuated building of Columbus Regional Hospital and began assessing damages. “It was surreal walking through a completely dark hospital. We lost everything to support the liveliness of what was just a few hours ago. Our primary and emergency electrical systems, boilers, chillers, and transport systems were all dead.”  In total, the hospital would sustain more than $200 million in losses.

Creativity and Resourcefulness Save Money, Speed Recovery

In the hours and days immediately following the flooding, Lenart worked tirelessly with FEMA, insurers, and area contractors to clear the hospital and get it back online. He tested all systems to determine what was salvageable and what was lost. Together with his team, he moved and consolidated storage facilities on the hospital campus to create a makeshift shipping and receiving area for supplies, systematically removed all food items from rooms and the kitchen to avoid infestations, stripped beds and gathered linens, removed trash and biohazardous wastes that might pose a threat to employees and contractors working in the building, and secured medication areas. Lenart enlisted contractors to pump water out of the basement – a lengthy process – and cut out drywall that could wick up water, causing further damage. He ordered dehumidifiers and worked with industrial hygienists to clean the air in the hospital and oversee cleaning of all the mud and muck that covered equipment, walls, desktops, and furniture.

In total, the hospital sustained more than $200 million in losses.

Conscious of the countless contractors and volunteers who would be working overtime to return the hospital to normal operations, Lenart provided any temporary solutions he could to aid rebuilding efforts. These included ventilating the building so it would not get stuffy or cause environmental problems, installing lights in the parking lot to help staff working at night feel safe, supplying power to the hospital’s mobile emergency department unit MED-1 and setting up a dietary unit to feed employees and volunteers.

When Columbus Regional Hospital physicians requested heavy surgical equipment from the hospital’s second floor so they could continue to practice at area surgery centers, Lenart and his team got creative. Elevators were not functioning so they devised a way to get a forklift to the second floor, opened up an area of a balcony and lowered large sensitive equipment from surgery to the ground floor. “We were extremely creative and resourceful to make this all happen,” said Lenart.

Lenart also moved quickly to ensure unnecessary expenditures did not hit the bottom line, suspending contracts with vendors and returning all consignments within one week of the flooding, selling back costly equipment, including a bone freezer, and recycling and reusing whenever possible. In the basement, for instance, maintenance staff stripped insulation off copper conductors destroyed by flooding and the hospital sold this as scrap. They also recycled batteries, chemical products, and metals.  Contractors moved 130,000 square feet of equipment from the basement, and hospital staff moved an additional 160,000 square feet of furniture and equipment from the first floor. The contents were cleaned and stored until they could be returned to the restored hospital.

Stringent FEMA guidelines required tight scopes of work that also would minimize cost exposures. Cautious not only of costs, but also AHJ requirements, Lenart’s group was required to have thought not just of every system and component of systems, but of every level of interactiveness those systems may have somewhere else in the hospital and demonstrate to insurers that they had thought through every detail and would have the equipment necessary to support the hospital in the way they had in the past. Determining, for instance, that they had everything from hammers and drills and complex diagnostic equipment to simple pots and pans, crash carts, shelving units, and chairs. All of this needed to be documented and accounted for.

Fortunately, Lenart had been asked to assess the hospital’s systems previously as part of routine risk assessment procedures so he had a big checklist in place to work through. And because the hospital already had planned a major rebuilding effort to begin in the fall 2008, he also had architects and engineers who knew the plant and contractors who were prepared to begin work.

Columbus Regional Hospital reopened in October 2008, five months after the flooding.

Less than five months after Haw Creek overflowed its banks behind Columbus Regional Hospital and flooded the building, the hospital reopened.  Creativity, resourcefulness, and relentless effort from Lenart, the facilities team, countless contractors, consultants, architects, hospital staff, and community volunteers brought a great hospital back online quickly.

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TFM asked Lenart about what changes, if any, have been made in the hospital’s emergency response plan, since the flooding in June 2008.

TFM: Have you and your team added guidelines to the emergency response plan for if the creek overflows again?
Lenart: Yes, we have a two part solution. Our short-term solution is to protect the loading dock from becoming the breach into our facility a second time. We’ve installed a temporary flood wall that will protect us from the rising waters of the Haw Creek. The second solution is building a permanent flood barrier that will protect the entire perimeter of the building from any future possible flood waters.

TFM: And have there been any other changes/additions made to the emergency response plan overall?
Lenart: The change we incorporated is to be more involved with our county emergency management officials. In particular, with flooding as being an event, we are closely in tune with the city emergency response to understand the environmental conditions that are happening “up stream.” Along with assessing future weather conditions, we now can actively determine and execute the next level of protective measures to insure protection of the facility.

(Photos courtesy of Columbus Regional Hospital)

Visitors view newborns in the Hello Kitty-designed maternity ward, at the Hau Sheng hospital. (AP Photo Credit/Wally Santana)

Back in 2006, Hau Sheng Hospital in Yuanlin, located 95 miles outside of Taipei, latched on to the benevolent cartoon symbol associated with all things cute, pink, and cuddly—Hello Kitty. Visitors of the hospital’s maternity ward (which has now delivered about 2,000 babies since its adoption of the Hello Kitty theme) are inundated with images of the cheery, mouthless anime icon, which is appearing exclusively on everything from nurse’s uniforms to blankets to room decor to birth certificates.

Emily Co of Kaboodle writes,

The Hau Sheng clinic was built in 2006 with a capacity of 30 beds, and its Kitty theme has been officially approved by Sanrio Co., Ltd. Hospital director Tsai Tsung-chi told Reuters his reasoning behind this madness: “I wish that everyone who comes here, mothers who suffer while giving birth and children who suffer from an illness, can get medical care while seeing these kitties and bring a smile to their faces, helping forget about discomfort and recover faster.”

The brainchild of Hospital Owner Tsai Tsung-ji, the Hello Kitty theme was actually the suggestion of his family—specifically his wife, mother and daughter—under the pretense the ominpresent symbol would be a calming influence on patients. “When new moms feel anxious and lost about how to deal with their new babies, Hello Kitty can make them more relaxed and reduce their sense of discomfort while giving birth,” said Tsai. (Source: Debby Wu, Associated Press.)

Among the first mothers to give birth in the Hello Kitty themed hospital was Chen Shing-chiu, 38, mother of a newborn baby boy. “Unlike traditional hospitals that are mostly white, I feel this one is pretty good,” she said. “I like Hello Kitty very much myself.”

The Hello Kitty brand celebrated its 34th birthday this year and still retains a healthy fan base both in its native Japan and abroad, mainly made up of young females who consider her the epitome of cuteness. Earlier this year the cartoon character even graced the cover of Japanese Vogue. (Source: Junior’s Book)
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[Reuters Photo Credit/Christine Lu.]

The Hau Sheng hospital claims to be one of a kind in terms of its “therapeutic” feline decor, but considering the popularity of Hello Kitty, it’s only a matter of time before that status will change.